About Professionals Package 2017/06 │ Proposal

IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL

Obtaining a Quotation To minimise delays in obtaining a quotation please provide complete answers to all questions in this proposal and attach relevant brochures, CVs, etc. that you believe will help us understand your business.

Your Duty of Disclosure Before you enter into a contract of general insurance with us, you have a duty under the Insurance Contracts Act 1984, to disclose tous every matter that you know, or could reasonably be expected to know, is relevant to our decision whether to insure you, and if so,the terms and conditions on which we will insure you.

You have the same duty to disclose those matters to us before you renew, extend, vary or reinstate a contract of general insurance.

Information you do not need to give Your duty, however, does not require disclosure of any matter: • that reduces the risk to be undertaken by us; • that is of common knowledge; • that we already know or should know in the ordinary course of our business as an insurer; • that has been indicated by us as not necessary for us to know.

Non-disclosure If you fail to comply with your duty of disclosure, we may be entitled to reduce our liability under the contract in respect of a claim,or may cancel the contract. If your non-disclosure is fraudulent, we may also have the option of avoiding the contract from itsbeginning.

Defence Costs & Averaging Provision General Conditions within the policy provides that if your liability for any Claim is for an amount in excess of the amount of the limitof liability, then we, under Section 2 and Section 3 of this policy shall only cover the same proportion of such defence costs as thelimit of liability bears to the total amount to be paid dispose of the claim (exclusive of defence costs).

Claims Made and Notified Policy The cover provided under Section 2 and Section 3 of this policy operates on a ‘Claims Made and Notified’ basis. This means that thepolicy only covers you for claims made against you and notified to us in writing during the period of insurance.

Where a ‘Retroactive Date’ is specified in your policy schedule, your policy only covers any claim made against you during the periodof insurance that arises from any conduct, act, error or omission that occurred on or after the Retroactive Date.

Section 40(3) of the Insurance Contracts Act 1984 (Cth) provides that where an insured gives notice in writing to the insurer of factsthat might give rise to a claim against the insured as soon as reasonably practicable after the insured became aware of those factsbut before the period of expiry, the insurer is not relieved of liability under the insurance contract in respect of the claim, by reasononly that it was made after the expiration of the period of insurance.

The above right arises solely under Section 40(3) of the Insurance Contracts 1984 (Cth) and not under your insurance policy.

Liability assumed by you under a contract or agreement It is not possible for you to transfer to us the entire spectrum of legal liabilities which you may be compelled to bear under the termsof a wide variety of Indemnity and/or Hold Harmless Clauses frequently inserted into commercial business contracts by principals,lessors or other parties.

Liability assumed by you under contract or agreement is only covered to the extent described in your insurance policy.

Prior to accepting legal liability for loss, destruction, damage or injury, which would not otherwise have attached to you at law, youshould contact your insurance broker to enquire whether your insurance policy covers such liability or, if not, whether it may be soextended.

Subrogation Agreements Where another person would be liable to compensate you for any legal liability for loss, destruction, damage or injury otherwisecovered by this insurance, but you have agreed with that person either before or after the loss, destruction, damage or injury

about Professionals Package 2017/06 │ Proposal of 15

occurred that you would not seek to recover any monies from that person, we will not cover you under this insurance for such legalliability for loss, destruction, damage or injury.

Privacy About Underwriting value the privacy of your personal information and we will ensure the handling of your personal information isdealt with in accordance with the Privacy Act 1988 (Cth) (the Act) and the relevant Australian Privacy Principals. Our full privacypolicy can be accessed at aboutunderwriting.com.au

When we provide insurance products and/or services, we ask you for the personal information we need to assess applications forinsurance policies, to administer and manage insurance policies and to investigate and handle claims. This can include a broad rangeof information ranging from your name, date of birth, address and contact details to other information about your personal affairsincluding your profession, financial affairs including financial statements, any criminal convictions or claims.

We may need to disclose personal information that you provide us to contractors, coinsureds, insurers and underwriters (who maybe located overseas), lawyers, claims adjusters and others engaged by About Underwriting to enable them to administer policies orhandle claims. Regardless of the information shared, we will take all reasonable steps to ensure that the above parties protect yourinformation in the same way that we do.

Our Privacy Policy shown in the above link contains information about how you can access the information we hold about you, askus to correct it, or make a privacy related complaint. You can obtain a copy from our Privacy Officer by emailing [email protected]

Consent By visiting any of our websites, online quotation systems, applying for, renewing or using any of our products or services you agreeto your information being collected, held, used and disclosed as set out in our Privacy Policy.

Complaints or DisputesIf you wish to make a complaint about our products or services, or a Privacy breach, you can contact us [email protected] or [email protected] Please refer to our complaints & disputes processdetailed at aboutunderwriting.com.au

If this does not resolve the matter or you are not satisfied with the way a complaint has been dealt with, you should contact:

Lloyd’s Underwriters’ General Representative in AustraliaLevel 9, 1 O’Connell St

Sydney NSW 2000Telephone Number: (02) 8298 0783

Email: [email protected]

who will refer your dispute to the Complaints team at Lloyd’s.

Complaints that cannot be resolved may be escalated to an independent dispute resolution body; Financial Ombudsman ServicesLimited (FOS). This external dispute resolution body has the ability to make decisions of which About Underwriting are obliged tocomply.

Contact details are:

Financial Ombudsman Services Limited Phone: 1800 367 287 Email: [email protected] Internet: http://www.fos.org.au GPO Box 3, Melbourne, VIC 3001


http://www.aboutunderwriting.com.au/

http://www.fos.org.au/

mailto:[email protected]






This Proposal is for Professional Indemnity; specific to Professionals (Miscellaneous Professional Companies and Consultants). Additional sections such as General and Products Liability, Management Liability, Cyber Liability and Statutory Liability are available as part of the about Professionals Package. Addenda can be found at the end of this Proposal.

“You/your” in this Proposal means the “Named Insured”.

1. Named insured(s):

2. Trading name(s):

3. ABN: Are you registered for GST?

4. Web address(es):

5. Principal business address:

6. Other business locations:

7. Please provide a detailed description of the Professional Services:

Please attach any relevant brochures or other documentation.


About you

About the business

Professionals Package Proposal

Yes No

8. Business commencement date:

9. Principals, Partners or Directors details:

Name of Principals, Partners orDirectors

Age Qualifications Date Qualified(DD/MM/YYYY)

Years Practising asPrincipal

This Practice

Previous Practice

10. a) Employees Number of Staff

Principals/Partners/Directors

Qualified Staff

Administrative/Clerical

Other (Specify)

Total

b) Total Payroll

Payments to Consultants/Contractors

Payments to Labour Hire Workers

11. Please list your professional memberships:

12. Professional Fee income:

Past financial year: Current financial year: Next financial year:

13. Please state the percentage of fee income derived from each of your declared business activities in the past financial year:

Activities Percentage of fee income

Cont.


Total

14. Do you expect these percentages to change in the next financial year?

If Yes, please provide details:

15. Please provide a percentage split of the states in which you generate your fee income:

ACT: NSW: NT: QLD: SA:

TAS: VIC: WA: O/S: Total:

16. Have you been licensed and registered in all states and territories in which you conduct your business since the business commencement date? If No, please provide additional information:

17. Do you conduct business overseas? If Yes, please provide details:

18. Has the name of your business ever changed or have you ever operated your business under a different corporate entity? If Yes, please provide additional information:

19. Has your business amalgamated, merged or acquired any other business or practice?

If Yes, please provide additional information:

20. Is any Principal/Partner/Director associated or connected with any other business?


21. Does any one client represent more than 25% of your annual income?

If Yes, please provide additional information:

22. Are written reports provided to clients?

If Yes, please provide sample copies along with details of disclaimers used in connection with such reports.


Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Duties

23. a) Are duties segregated so that no one person can control signing cheques, preparing cheque requisitions, reconciling bank statements orissuing fund transfer instructions above $5,000, from commencement to completion without referral to another party (i.e. financial controller or director)?

b) Are duties segregated so that no one person can control refund of monies or return of goods above $5,000, from commencement to completion without referral to another party (i.e. financial controller or director)?

c) Are all employees required to take a minimum of two weeks uninterrupted annual leave per year?

24. Do you require Fidelity Cover?

If Yes, please select your preferred sub-limit:

$50,000 $100,000 $250,000

NB. The following claims questions relate to all matters of all policy sections, ie: Professional Indemnity, General and Products Liability, Management Liability, Cyber Liability and Statutory Liability:

25. After full enquiry of all your employees, has any insurance claim been made against you or your business or that of any principal, partner, director or employee in this or any other business?


Date Notified (DD/MM/YYYY)

Insurer Description Amount Paid Maximum Potential Loss

Finalised or Open

Claimant Name

26. Are you aware of any circumstances or incidents which may result in a claim being made against you or your business or the business of any principal, partner, director or employee?

If Yes, please provide details of circumstances or incidents:


About your Claims

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

27. Have you or any of your employees ever been the subject of any disciplinary proceedings or actions for misconduct in a professional respect whilst in this or any other business?

If Yes, please provide details of proceedings or actions:

28. Have you, your principals, partners, directors or predecessors in business had insurance declined, cancelled, refused or had any special terms imposed?


29. Do you currently have Professional Indemnity insurance in force for the activities for which cover is being proposed?

If yes, please provide the following details:

Insurer Renewal Date Limit of Indemnity Deductible Premium

30. Please select which Limit of Indemnity is required for Professional Indemnity:

$1,000,000 $2,000,000 $5,000,000 $10,000,000 $20,000,000 Other

31. Please select your preferred Deductible for Professional Indemnity:

$1,000 $2,500 $5,000 $10,000 $25,000 Other


About your cover

Yes No

Yes No

Yes No

Only complete this section if General and Products Liability cover is required

32. Do you require a quotation for General and Products Liability insurance?

If Yes, please complete the following questions:

33. What is your estimated annual turnover (if different to fee income) for the next 12 months?

34. What are your estimated annual wages for the next 12 months?

35. Please select which Limit of Indemnity is required for General and Products Liability:

$5,000,000 $10,000,000 $20,000,000 Other

36. Please select your preferred Deductible for General and Products Liability:

$1,000 $2,500 $5,000 $10,000 $25,000 Other

Contractors Exposure

37. Please provide the estimated payroll (wages) for contractors, subcontractors and/or labour hire for the upcoming period of insurance:

White Collar:Contractors Subcontractors Labour hire Blue Collar:Contractors Subcontractors Labour hire

38. Please state nature of work carried out by subcontractors, contractors and/or labour hire:

39. Do you ensure that sub-contractors, contractors and/or labour hire have their own General and Products Liability Insurance in place and request certificate of currencies as evidence?

Contractual Liability

40. Do you assume any liability under contract or hold harmless other parties under contract?


41. Do you engage any in-house legal counsel and/or external legal providers to review contractual agreements?



General and Products Liability Addendum

Yes No

Yes No

Yes No

Yes No

42. Do you require cover for goods in care, custody or control in excess of $100,000?

a) If Yes, what amount:

b) What is it for?

43. Do you perform any hands-on / manual type work?

a) If Yes, what percentage of hands-on / manual type work is undertaken?

b) Description of hands-on / manual type work undertaken:


Yes No

Yes No

Only complete this section if Management Liability cover is required44. Do you require a quotation for Management Liability insurance?


45. Please select which Limit of Indemnity is required for Management Liability:

$500,000 $1,000,000 $2,000,000 $5,000,000 $10,000,000 Other

46. At last financial year end, please state:Net Profit

Gross Total Assets

Gross Total Liabilities

47. Do you require Employment Practices Liability?


$250,000 $500,000 $1,000,000 $2,000,000 $5,000,000 Other

48. Retrenchments in the last 12 months/next 12 months: Number last 12 Months:

Estimate next 12 Months:

49. Are all employees provided with written employee procedures (e.g. Employee Handbook)?

50. Do you require Statutory Liability?


$100,000 $250,000 $500,000 $1,000,000

51. Have you suffered any Occupational Health & Safety breaches in the last 5 years?


52. Do you require Crime Cover?


$50,000 $100,000 $250,000 $500,000


Management Liability Addendum

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

53. How often is an independent physical review of stock reconciled against inventory records?

Weekly Monthly Annually Other

54. Are there any facts or circumstances that may affect the ability of the company to meet all its debts as and when they fall due?


55. Do you require Internet Liability?


$50,000 $100,000 $200,000

56. Please advise the number of websites cover is required for:

57. Please list website addresses requiring cover:


Yes No

Yes No

Only complete this section if Cyber Liability cover is required

58. Do you require a quotation for Cyber Liability insurance?


59. Have there been any data breaches in the last 5 years?


60. How much of your business is transacted online?

61. Do you store payment card details on your network?

62. Are you compliant with the latest payment card industry data security standard?

63. Please detail which of the following data types you collect:

a) Third Party Corporate Confidential Data

b) Credit and Debit Payments

c) Credit History or Credit Rating

d) Medical or Health Records

64. How many individual records are stored on your system?

65. Do you have a fully documented and tested business continuity plan in place?

66. Are your IT systems hosted on the company’s own server or hosted by an external service provider?

67. Does your or your external service provider’s IT systems comply with the following security requirements?

a) Is anti-virus software installed on all desktops and servers?

b) Are all external network gateways protected by a firewall?

c) Is all critical data backed up at least weekly?

If No to any of the above, please provide details:

68. Please select which Limit of Indemnity is required for Cyber Liability:

$50,000 $100,000 $250,000 $500,000

$1,000,000 $2,000,000 $5,000,000 Other


Cyber Liability Addendum

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Only complete this section if separate Statutory Liability/Legal Costs cover is required

69. Do you require a quotation for Statutory Liability/Legal Costs insurance?


70. Have you suffered any Occupational Health & Safety breaches in the last 5 years?


71. Have you attained a Quality Insurance Certification to ISO 9000 series or industry-specific accreditation peculiar to workplace or environmental procedures?

72. Do you have a current manual for Occupational Health & Safety Procedures and Environmental Protection Procedures and are these manuals distributed to all employees?


73. Do you have a safety management system in place, including a risk register?

74. Have you ever had a penalty or premium loading imposed on your Workers Compensation insurance?


75. Please select which Limit of Indemnity is required for Statutory Liability and Legal Costs:

Statutory Liability

$500,000 $1,000,000 $2,000,000 $5,000,000 Other

Legal Costs $500,000 $1,000,000 $2,000,000 $5,000,000 Other

76. Do you have Statutory Liability cover under any of your other insurances? (i.e. Management Liability, Professional Indemnity, General and Products Liability)?



Statutory Liability/Legal Costs Addendum

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Additional Information

If insufficient space to complete questions, please provide at this section:

I acknowledge that I have read and understood the important notices and privacy statement contained in this proposal and addenda. Where I have provided information about another individual, I declare the individual has been made aware of the facts contained in the important notices and privacy statement.

I agree that this proposal and addenda together with any other information or documents supplied shall form the basis of the contract of insurance.

I declare that I am authorised to complete this proposal form and addenda on behalf of the Insured and that to the best of my knowledge the statements, particulars and information contained in this proposal and addenda and any other documents accompanying this proposal and addenda are true and correct in every detail and that no material facts have been misstated or omitted.

I undertake to inform about Underwriting of any material alteration to those facts before entering into a contract of insurance.

Date: Name:

Position: Signature:

ABN 78 608 848 479 AFSL 483210PO Box 16106, Collins Street West VIC 8007

Suite 302, 546 Collins Street, Melbourne VIC 3000Telephone: (03) 9998 9080

Fax: (03) 9998 [email protected]

aboutunderwriting.com.au


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About Professionals Package 2017/06 │ Proposal · This Proposal is for Professional Indemnity;...

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